Jones Fiona
Faculty of Health and Social Care, 2nd floor, Grosvenor Wing, St George's University of London, UK.
Disabil Rehabil. 2006;28(13-14):841-7. doi: 10.1080/09638280500534952.
Social Cognition Theory and the cognitive construct of self-efficacy often form the theoretical basis for many chronic disease self-management programmes. Self-efficacy can be influenced through these programmes and has been shown to be predictive of greater levels of functioning and psychological well-being. Stroke is regarded as a complex chronic disability, and individuals may share many of the same concerns as those living with other chronic diseases such as arthritis and chronic pulmonary disease. However there has been minimal reported research on the utility of self-management programmes following stroke.
To comprehend the composition of chronic disease self-management programmes which could be applied to stroke, this paper examined the theoretical basis of self-management and particularly the evidence relating to interventions which have utilized self-efficacy enhancing strategies. Selected papers were retrieved from an extensive search of literature using Medline, Cinahl, PsychInfo and Web of Science databases and the Cochrane Collaboration. The search request focused on literature that specifically related to chronic disease, self-management and self-efficacy that had been published since 1995. However, seminal literature on self-efficacy produced prior to this date was also included.
There is strong evidence to support the use of self-management programmes and their effect on self-efficacy and associated health outcomes. While there are differences in the nature of each chronic condition, there are similarities in the core skills required for self-management. Many effective strategies could be incorporated into current stroke rehabilitation programmes or used to develop targeted self-management interventions. Future research which informs stroke rehabilitation should utilize the evidence relating to other chronic conditions. This could be used to develop the most effective methods of equipping individuals following stroke to cope confidently with the transition from being discharged from therapy towards effective self-management in the longer term.
社会认知理论以及自我效能的认知结构常常构成许多慢性病自我管理项目的理论基础。自我效能可通过这些项目受到影响，并且已被证明能够预测更高水平的功能和心理健康状况。中风被视为一种复杂的慢性残疾，患者可能与患有关节炎和慢性肺病等其他慢性病的人有着许多相同的担忧。然而，关于中风后自我管理项目效用的研究报道极少。
为了理解可应用于中风的慢性病自我管理项目的构成，本文审视了自我管理的理论基础，尤其是与采用自我效能增强策略的干预措施相关的证据。通过使用Medline、Cinahl、PsychInfo和Web of Science数据库以及Cochrane协作网对文献进行广泛检索，获取了选定的论文。检索请求聚焦于自1995年以来发表的与慢性病、自我管理和自我效能具体相关的文献。不过，在此日期之前产生的关于自我效能的开创性文献也被纳入其中。
有充分证据支持自我管理项目的使用及其对自我效能和相关健康结果的影响。虽然每种慢性病的性质存在差异，但自我管理所需的核心技能存在相似之处。许多有效的策略可纳入当前的中风康复项目，或用于开发针对性的自我管理干预措施。为中风康复提供信息的未来研究应利用与其他慢性病相关的证据。这可用于开发最有效的方法，使中风患者能够自信地应对从出院后的治疗过渡到长期有效的自我管理。
